Healthcare Provider Details

I. General information

NPI: 1437568615
Provider Name (Legal Business Name): FARREL JOHN VILLEJOIN R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2014
Last Update Date: 10/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 N PARKERSON AVE
CROWLEY LA
70526-3613
US

IV. Provider business mailing address

1002 N PARKERSON AVE
CROWLEY LA
70526-3613
US

V. Phone/Fax

Practice location:
  • Phone: 337-783-7200
  • Fax: 337-788-0170
Mailing address:
  • Phone: 337-783-7200
  • Fax: 337-788-0170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11459
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: